Provider Demographics
NPI:1154416816
Name:REINES, ERIC JAY (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JAY
Last Name:REINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1005
Mailing Address - Country:US
Mailing Address - Phone:339-883-1207
Mailing Address - Fax:781-595-5479
Practice Address - Street 1:62 MARKET ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1005
Practice Address - Country:US
Practice Address - Phone:339-883-1207
Practice Address - Fax:781-595-5479
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45816207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0122009Medicaid
MA0122009Medicaid
MAA22788Medicare ID - Type Unspecified